| NPI | 1285055236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1250750) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 9990) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2021-04-07 |